Essay Composing a song to teach about dengue fever
Lancet 2006; 368: S22–S23
The printed
journal
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Zenobia Chan has much
teaching experience at both
undergraduate and master level.
She has published more than
30 papers related to health
issues, mental health, medical
education, nursing, counselling,
poetry, social work, qualitative
studies, and women’s studies.
She has prepared two Chinese
course materials, on effective
communication and
interpersonal relationships in
2004 and women’s health in
2006. She is currently writing
two Chinese books: one about
moral education stories for
children and the other about
effective parenting.
Centre for Health Education
and Health Promotion, School
of Public Health, Faculty of
Medicine, Chinese University of
Hong Kong, Hong Kong
(Prof Z C Y Chan PhD)
Correspondence to:
Prof Zenobia Chan
zehippo@yahoo.com
Penny Osmond
S22
Zenobia Chan
Study of topics related to medicine can be a less than
interesting experience for students who do not already
have a solid grounding in the subject. Unfamiliar medical
terminology and the complexities of disease manifestation
and treatments give students the perception that medical
subjects are unrelated to their daily lives and not
accessible. But health is everyone’s business, and we all
have a responsibility to learn about healthy lifestyles and
to acquire a certain amount of basic medical knowledge.
Adolescents are quick learners, and exposure to these
ideas allows them to adopt healthy habits early in life.
I teach various health-related courses. This essay
illustrates a new teaching method for undergraduates
who are majoring in the arts, social sciences, or business
studies. In education of undergraduates, creativity, active
involvement, and critical thinking are effective. Productive
and positive activities improve the critical thinking
process. Teachers must provide opportunities for learners
to engage actively in the learning process. Reflective and
creative interaction in a group can be fostered by
providing the students with a sense of active involvement
in, and personal ownership of, the learning process.
Group dynamics enhance mutual support and allow
students to share their views and create new learning
situations. Use of imagination and exploration of
alternative ways to represent knowledge can also facilitate
the process of critical thinking. To apply these ideas, I
invited my students to compose a song about dengue
fever, hoping to cultivate their motivation to learn and to
offer a new type of exercise that would allow them to
share ideas with their peers and me.
The exercise lasted 3 hours. First I gave a lecture that
consisted of a PowerPoint presentation, covering
transmission route, signs and symptoms, treatment,
and preventive measures, and a videotape of a Cantonese
television programme about dengue fever. The visual
aids provided a vivid picture of the illness as experienced
by several patients. During the 15 minute question
and answer session that followed, the 30 students
were encouraged to request clarification of any mis-
understandings. I also asked some questions to assess
the students’ degree of understanding—eg, What does a
mosquito look like? What are the signs and symptoms
of the illness? How is it treated and how can it
be prevented?
After a break, I asked the students to form six groups.
They were excited and did not know what I expected of
them. A sense of curiosity and uncertainty was created.
All the students became very animated and asked me
what they should do. I finally told them that they had
40 minutes to compose a song about dengue fever. Their
objectives were to show me what they had learned from
the lecture, and to apply that learning in a very original
and creative way. Apart from the basic facts of the topic,
there were no right or wrong answers. It was up to them
to decide about the melody, pace, and style of the musical
piece, and they should write the lyrics as a team. The
song should not last longer than 3 minutes. When the
composing time was up, each song would be performed
in front of the class. They could sing the song as a group
or have one or more members of the group sing it.
Most of the students were self-motivated and active in
the discussion. Two were quiet but both jotted down the
points suggested by their groups. Some students sang
the lyrics; some proposed the rhythms. Some suggested
when to pause, whether to use a major or minor key, or
whether the song should be classical or contemporary.
Some watched the clock and reminded the group
members of the time remaining. Overall, they actively
participated in the composition and worked with their
classmates in an atmosphere of mutual trust and
appreciation for each other’s talents as composers and
innovators.
When time was up they wanted longer, of course, but
in fairness to all I had to insist that all groups stop work.
I commended them for their voluntary involvement and
high spirits in learning. I asked how they’d like to decide
on the order of presentation. They decided to do so by a
show of hands.
The first group used the tune from the nursery song
“London Bridge is falling down,” with original lyrics about
the transmission route, signs and symptoms, and the
www.thelancet.com Medicine and Creativity Vol 368 December 2006
characteristics of the mosquito. The two boys in the
group sang the song and the three girls pretended to play
instruments.
The second group adapted two pieces of Cantonese pop
music and wrote a song about the patient’s disease
experience in a humorous way. All the members of this
group performed together.
The third group did a rap song, which they wrote in
Mandarin, the key language of China and many Chinese
societies. This choice was surprising, because Cantonese
is spoken much more than Mandarin in Hong Kong.
Two girls were chosen by that group to perform; they did
so with smiles. The three other members (two boys and a
girl) remained in their seats but showed great support for
the pair.
The fourth group adopted a romantic Cantonese song
melody and wrote lyrics about the sadness of infected
patients who might die and not see their families again.
The song aimed to remind people to take precautions
against dengue fever to stay with their loved ones and
enjoy a healthy life. This song had a sense of sorrow.
The fifth song had only four lines: the first was about the
causative agent; the second about the severe prognosis of
this disease; the third about the treatment regimen; and
the last about the importance of environmental hygiene.

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The melody was written by the group. The song could be
easily remembered by anyone, even very young children.
The sixth group composed a song without a particular
melody and the content was not well structured or
organised. This group used many non-verbal behaviours
such as nodding their heads, waving their hands, and Investment in education and equipping of adolescents Further reading
dancing. The song did not really capture the importance with sound medical knowledge can improve their health, Boud D, Keogh R, Walker D, eds.
of learning about dengue fever; the group expressed their help them take care of their families’ health, and allow Reflection: turning experience
into learning, London: Kogan
experience through dance. It was quite abstract and them to have a constructive role as health promoters in Page, 1998.
required imagination to understand what they were their communities. Therefore, we can benefit from Brookfield S. What it means to
trying to say about dengue fever. What this group did was knowing which teaching approaches are well received by think critically. In: Developing
radically different from the work of the other five groups, students in medical courses. What are their responses to critical thinkers: challenging
and was beyond my frame of reference as well. various learning processes? I strive to explore this adults to explore alternative
ways of thinking and acting.
The approach of asking a group of students to compose question in my teaching career so as to make medicine San Francisco: Jossey–Bass, 1987:
a song has limitations, of course. First, students who are an approachable and useful subject for non-medical 3–14.
not interested in composition and singing might not be students. Use of song composition was a new experience Carlisle C, Cooper H, Watkins C.
motivated by this activity. Therefore, teachers should for the students and me. It allowed me to expand my “Do none of you talk to each
assess the students’ personalities and readiness to work conceptualisation of teaching, by letting me try new other?”: the challenges facing the
implementation of
with their classmates. This learning method would be teaching methods and allowing me to experience the interprofessional education.
best introduced later in a course, after the students have inherent uncertainties in doing so. Medical education Medical Teacher 2004; 26:
had a chance to get to know each other and the teacher. has been described as outcome-based education. 545–52.
Second, there is no objective way to assess the students’ Composition of a song to master medical knowledge can Harden RM, Crosby JR, Davis MH.
degree of understanding of a subject simply by listening be regarded not only as outcome based, but also as AMEE guide number 14.
Outcome-based education,
to a song they have written. Therefore, composition process based, because every group member has to
part 1—an introduction to
should be regarded as a learning activity rather than an contribute to the discussion and negotiation before the outcome-based education.
evaluation method. song can be completed. Medical Teacher 1999; 21: 7–14.

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